Long-Term Care

Guidelines for Performing Range of Motion Exercises

LTC Clinical Pearls: Powered by HCPro's Long-Term Care Nursing Library, February 19, 2013

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Guidelines for ROM exercises are:

  • Follow the care plan and know the goals for the resident.
  • Find out whether a movement is contraindicated for any joint.
  • Become familiar with the resident’s diagnoses, abilities, and limitations.
  • Use good body mechanics for yourself and the resident. Elevate the bed to a comfortable working height.
  • Be sure the resident is dressed or covered with a bath blanket for modesty. If the resident cannot be dressed, applying underwear will support dignity. Expose only the joints you are working on.
  • Do the activity in a private area that has enough space for moving the extremities.
  • Position the resident properly in good alignment for the activity. Make sure he or she is comfortable.
  • Explain the procedure to the resident, even if he or she is unresponsive or cognitively impaired.
  • If the resident refuses the activity, try to coax him or her. For example, try singing an old song that distracts the resident. Invite the resident to sing along with you. You may find that exercising in the bathtub or whirlpool is easier and much more relaxing for the resident. If he or she continues to refuse, inform the nurse.
  • Support the extremity above and below the joint being moved. Use the palm of your hand, keeping the hand open. Do not grip.
  • Move each joint to the point of resistance, not beyond.
  • Move each joint as far as possible without causing pain. Never force a joint past the point of pain.
  • Monitor for signs of joint or soft-tissue swelling; if noted, stop the activity and notify the nurse.
  • Monitor for signs of pain in residents who cannot verbalize, such as resisting, grimacing, and guarding.
  • Avoid internal rotation and abduction beyond the midline if the resident has had joint replacement surgery.
  • Work from the top of the body to the bottom.
  • Do each movement slowly and smoothly. Come to a complete stop before continuing.
  • Research has not identified an ideal amount of ROM for prevention or treatment. This varies widely with the nature of the contracture, medical condition, and individual needs. In most facilities, ROM is given at least twice a day. Perform each motion five to 10 times, or as specified on the plan of care.
  • A muscle spasm, or clonus, is a rapid, jerking movement. Spasms are strong and painful. If a spasm occurs, stop the exercise and hold gentle, steady, and slow pressure on the extremity until the muscle relaxes. Stop if the resident complains of pain. Continue if it is not painful for the resident.
  • If the resident cannot relax a joint, bend the next closest joint slightly. For example, bend the elbow to relax the wrist; bend the knee to relax the ankle.
  • In some facilities, nursing assistants are not permitted to perform ROM exercises on the neck, while in others, a doctor’s order is needed for neck ROM. Perform this procedure only if permitted to do so.
  • Hyperextension of the neck is not possible with the resident in a supine position.
     



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